April 21 update: Michigan to identify nursing homes infected by the coronavirus
As deaths from the coronavirus mount in Detroit nursing homes, the city crafted a plan this week to have medical students visit each facility to test for the virus.
By its count — almost certainly an undercount —at least 14 of Detroit’s 27 nursing homes had confirmed COVID-19 infections, with 12 reported deaths.
But what the city will not do is tell the public which nursing homes are infected.
Nor will health officials in surrounding Wayne County.
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Nor, for that matter, will the Michigan Department of Health and Human Services, the agency charged with overseeing the state’s response to the pandemic.
Health officials cite several reasons for withholding basic information about a deadly contagion that impacts vulnerable patients, their families and nursing home staff, including privacy concerns, and not wanting to put “undue stress” on nursing homes.
The resistance confounds public health leaders as well as watchdog groups for nursing homes and other long-term care facilities. They argue the government should be leading efforts to identify the path of COVID-19, particularly when it involves the elderly, who are more vulnerable to the coronavirus.
“Consumers need to know where outbreaks are happening,” said Marianne Udow-Phillips, executive director of the Center for Health and Research Transformation at the University of Michigan.
“It is very important for families to know what the situation is at different nursing homes. “
The state’s refusal to identify nursing homes is at odds with a growing number of states during the coronavirus pandemic.
In Washington state, where the Life Care Center of Kirkland registered 167 infections and 37 deaths, the state Department of Social and Health Services on Wednesday listed the names and locations of 137 long-term care facilities with COVID-19 cases, broken down by nursing homes, assisted-living centers, adult family homes and other facilities.
Connecticut lists nursing homes where residents test positive for the coronavirus, and breaks down state totals by residents who are sick, hospitalized or who have died from the virus. Tennessee said it would soon make public the long-term care facilities where workers contract COVID-19.
A national advocate for improved nursing home care called the lack of public disclosure by Gov. Gretchen Whitmer’s administration and local governments “a travesty.”
“You get a lot of lip service from the public sector, saying we are all in this together and we have to stay informed,” said Brian Lee, executive director of Families for Better Care, a Texas-based nonprofit advocacy group.
“This is a disservice to residents and health care workers and especially the families who are out there wondering if there is an outbreak in a loved one’s home.”
Families for Better Care gave Michigan an “F” grade in 2019, ranking it 45th nationally for nursing home care and 50th in the percentage of nursing homes with “severe deficiencies.” Bridge Magazine identified more than 80 Michigan nursing homes that have been cited for deficiencies in infection control and prevention in the past three years, including some that now have COVID-19 cases.
Lee said not disclosing nursing homes with COVID-19 also poses serious issues for families looking to admit a relative amid the coronavirus outbreak.
“The prospect of exposing your loved one unknowingly, that’s a real possibility,” he said.
No good numbers
Let’s start with the fact that Michigan has no reliable list of nursing homes or other long-term care facilities with confirmed COVID-19 cases. MDHHS does not currently track COVID-19 by nursing facilities, leaving it to the businesses that own or run nursing facilities to publicly acknowledge confirmed cases, or not.
The Health Care Association of Michigan (HCAM), an industry group, told Bridge last week that 10 to 12 Michigan nursing homes had confirmed cases, but would not name them.
Infections and deaths are almost certainly far higher than what’s been disclosed among the state’s 450 nursing homes.
Michael McElrath II, spokesperson for the Wayne County Health Department, told Bridge that building an accurate list of nursing home cases can be tricky.
“For the record, cases and deaths aren't recorded by nursing home facility, but by the resident's home address,” he said in a statement. “That makes this effort much more time-intensive for our teams to track down and cross-reference. Death is even more an issue as the certificates of death aren't always completed and input in the system in a timely and complete fashion.”
Udow-Phillips, who formerly ran the Michigan Department of Human Services, said it may take a while for the state to patch a reporting system that has been neglected for years.
“Fixing it now when it’s all hands on deck with a health care crisis is a triple challenge,” she said.
What the state has done, and what it hasn’t
To be sure, Michigan has taken several steps to protect nursing home residents.
On March 13, Whitmer signed an executive order restricting access to nursing homes and other residential-care facilities and screening visitors who are allowed in. MDHHS also has released bulletins freeing nursing homes from red-tape to give facilities more flexibility to provide beds and isolate residents during an unprecedented pandemic.
But the state health department has struggled to produce real-time data critical to everyone from hospital officials trying to balance patient loads, to ordinary people seeking the latest on the virus’ spread across the state. Whitmer and top health officials blame the state’s sluggish response on outdated, underfunded systems.
But that does not necessarily explain the reluctance of health departments to identify nursing homes struck by the virus.
Vickie Winn, spokesperson for the Detroit Health Department, told Bridge in a statement that the city would not release names “to preserve the privacy of these institutions, their residents and staff, details of COVID-19 testing are not being shared publicly at this time.”
The Wayne County Health Department, which oversees 39 nursing homes outside of Detroit, reported 111 COVID-19 cases earlier this week.
McElrath, its spokesperson, was also mum on naming nursing homes, though he said patients’ families and staffers are notified of positive cases.
“We are not sharing location as not to add undue stress and attention of those facilities and to avoid potentially compromising privacy and safety of residents and workers,” he said in a statement.
“Family members and those who are directly involved with the patients at those facilities have been notified through our contact investigations.”
On Tuesday, Joneigh Khaldun, the state’s chief medical executive, said MDHHS aims “to be as open and transparent as possible” on nursing homes during the outbreak.
But she conceded the state remains well short of meeting that goal.
“It's just a matter of us being able to use that data and then share it in an accurate and robust way with the public. So we are currently discussing getting that nursing home data from across the state … but quite frankly we’re not quite there yet, but it is something that we want to move forward with.”
Specifically asked Wednesday if MDHHS would publish a list of nursing homes with confirmed COVID-19 cases, department spokesperson Bob Wheaton told Bridge: “We’re working to generate a summary report that describes, in aggregate by county, the number of communal living outbreaks that have been reported to MDHHS by local health departments.”
He did not directly answer whether it would list those homes.
Public health experts widely agree nursing home residents are vulnerable to COVID-19, as death rates among the elderly are far higher than the overall average.
Detroit Medical Center epidemiologist Teena Chopra told the Huffington Post this week that nursing home patients account for at least 25 percent of metro Detroit’s explosive volume of coronavirus deaths.
“The virus has infiltrated nursing homes in Detroit, and that’s why these patients who are the weakest part of society are being fed to DMC and neighboring hospitals,” she said. “These are the ones with much higher mortality rates, who push the overall rate higher.”
“As far as management coming to us and telling us we need to be careful with this resident or that resident, that’s not the case,” a member of the nursing assistant team at Villa Ambassador told Bridge Magazine. She asked that she not be identified, saying staff are told they would be fired if they talked to the media.
She also said nursing staff have had no access to protective gowns and goggles when they had to bathe or reposition residents.
The union which represents staff at Villa Ambassador and 65 other Michigan nursing homes issued a letter Wednesday accusing the home of violating state and national guidelines for COVID-19.
According to Service Employees International Union, Healthcare Michigan, the home has refused to tell workers who tested positive for the coronavirus and told one employee to return to work with possible symptoms for COVID-19.
“One employee forced to work … was still suffering from a shortness of breath, unable to taste or smell, still has somewhat of a cough and a temperature of 99.5 degrees,” the union said.
Bridge reached out to media relations for Villa Healthcare, an Illinois-based firm which manages Ambassador, along with 11 other nursing homes in southeast Michigan, asking for comment about the SEIU accusations. It also left a phone message at the Detroit home but did not hear back from either source.
The Villa Ambassador website posted this message: “We understand that this is a time of anxiety and concern for many. Our reliance on factual data and scientific evidence allows us to implement changes aimed at minimizing the potential of exposure to COVID19 and planning for the care and treatment of any resident who may test positive for the virus.”
In the meantime, SEIU spokesperson Kevin Lignell said the toll from coronavirus at Ambassador continues. He said that interviews with nursing home staff found that at least two residents of the home have died of COVID-19. He said a nursing assistant died within the past few days from COVID-19 as well.
The elderly “are like flypaper for this coronavirus,” Dr. Peter Gulick, an infectious disease expert at Michigan State University, told Bridge last month. “The coronavirus sticks to them, and that's when the mortality [rates] go up.”
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